Women and National Health Insurance

No abstract available for this article.     

Rents From the Essential Health Benefits Mandate of Health Insurance Reform

The essential health benefits mandate constitutes one of the most controversial health care reforms introduced under the U.S. Affordable Care Act of 2010. It bears important theoretical and practical implications for health care risk and insurance management. These essential health benefits are examined in this study from a rent-seeking perspective, particularly in terms of three interrelated questions: Is there an economic rationale for standardized, minimum health care coverage? How is the scope of essential health services and treatments determined? What are the attendant and incidental costs and benefits of such determination/s? Rents offer ample incentives to business interests to expend considerable resources for health care marketing, particularly when policy processes are open to contestation. Welfare losses inevitably arise from these incentives. We rely on five case studies to illustrate why and how rents are created, assigned, extracted, and dissipated in equilibrium. We also demonstrate why rents depend on persuasive marketing and the bargained decisions of regulators and rentiers, as conditioned by the Tullock paradox. Insights on the intertwining issues of consumer choice, health care marketing, and insurance reform are offered by way of conclusion.     

Minority Response to Health Insurance Coverage for Mental Health Services

BACKGROUND: To promote access to mental health services, policy makers have focused on expanding the availability of insurance and the generosity of mental health benefits. Ethnic minority populations are high priority targets for outreach. However, among persons with private insurance, minorities are less likely than whites to seek outpatient mental health treatment. Among those with Medicaid coverage, minorities continue to be less likely than whites to use services. AIMS OF THE STUDY: The present study sought to determine if public insurance is as effective in promoting outpatient mental healthtreatment as private coverage for ethnic minority groups. METHODS: The analysis uses data from the 1987 National Medical Expenditure Survey to model mental health expenditures as a function of minority status and private insurance coverage. An interaction term between the two highlights any differences in response to private and public insurance coverage. The analysis uses a two stage least squares method to account for endogeneity of insurance coverage in the model. RESULTS: Minorities are less responsive to private insurance than whites in two ways. First, minorities are less responsive to private insurance than to public insurance whereas whites do not show this difference. Second, minorities are less responsive to private insurance than whites are to private insurance. DISCUSSION: Results suggest that there is a difference in the effectiveness of public and private health insurance to encourage use of mental health services. Among minorities but not among whites, those with private coverage used fewer mental health services than those with public coverage. Minorities were not only less responsive to private insurance than public insurance, but among those who were privately insured, minorities used fewer mental health services than whites. These results imply that insurance may not be as effective a mechanism as hoped to encourage self-initiated treatment seeking particularly among minority and other low income populations. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: These results suggest that increasing private insurance coverage to minority populations will not eliminate racial and ethnic gaps in professional help-seeking for outpatient mental health care. Although the total number of people receiving treatment might increase, these results suggest that whites would seek care in greater numbers than minorities and the size of the minority-white differential might grow. IMPLICATIONS FOR FURTHER RESEARCH: Areas for further research include the impacts of alternative definitions of mental health services, the dynamics of the substitution of inpatient for outpatient mental health care, elucidation of nonfinancial barriers to care for minorities, and determinants of timely help-seeking among minorities.     

日本全民医疗保障制度的启示

世界各国的医疗保障制度都和本国的政治、经济、文化有密切的关系。根据其覆盖情况、政府责任、制度功能等，可以归纳为五种制度模式：社会医疗救助制度模式、国家卫生服务保障制度模式、社会医疗保险制度模式、市场医疗保险制度模式、个人储蓄医疗保障制度模式。日本的法定医疗保险属于社会医疗保险制度模式。     

Public support for National Health Insurance.

In 1978 a majority of the American public felt there was a need for National Health Insurance (NHI). This study develops models of public support for NHI both with and without a tax subsidy. Support for NHI is highest among the young, lower socioeconomic groups, non-Whites, and urbanites. The older, more educated, White, and rural population are less supportive. In addition, substantial differences exist across political party orientation and health insurance status. Although support for NHI declines by considering a tax subsidy, logit estimates remain relatively stable. Only age and socioeconomic status lose statistical significance when the tax issue is considered.     

The Prospects for National Health Insurance Reform

This article explores the unequal access to health care in the context of efforts by the American Medical Association (AMA) and its allies to maintain a market-maximizing health care system. The coalition between the AMA and its traditional allies is breaking down, in part, because of converging developments creating an atmosphere which may be more conductive to national health care reform and the development of a reformed health care delivery system that will be accessible, adequate, and equitable in meeting the health care and related social service needs of the American people.     

Tax Incidence and Net Benefits in the Market for Employment-Related Health Insurance: Sensitivity of Estimates to the Incidence of Employer Costs

The market for employment-related coverage contains public transfers through the tax system and private transfers across workers with predictably different risks. We examine both transfers across a wide range of employee characteristics, including age, race, ethnicity, family size, poverty level, and health risk. To resolve longstanding questions regarding the incidence of employer contributions, we simulate a range of alternative incidence scenarios in which (i) all employees offered coverage in a firm share equally in the employer's costs, (ii) burdens are narrowly targeted according to employee-specific health risks, and (iii) intermediate cases with burdens targeted by job characteristics, age, sex, race, ethnicity, and family size. Our results provide evidence regarding the distribution of tax subsidies and net benefits under a range of scenarios that we believe bound the true incidence of employer premium contributions.     

Necessary Health Care and Basic Needs: Health Insurance Plans and Essential Benefits

According to HealthCare.gov, by improving access to quality health for all Americans, the Affordable Care Act (ACA) will reduce disparities in health insurance coverage. One way this will happen under the provisions of the ACA is by creating a new health insurance marketplace (a health insurance exchange) by 2014 in which “all people will have a choice for quality, affordable health insurance even if a job loss, job switch, move or illness occurs”. This does not mean that everyone will have whatever insurance coverage he or she wants. The provisions of the ACA require that each of the four benefit categories of plans (known as bronze, silver, gold and platinum) provides no less than the benefits available in an “essential health benefits package”. However, without a clear understanding of what criteria must be satisfied for health care to be essential, the ACA’s requirement is much too vague and open to multiple, potentially conflicting interpretations. Indeed, without such understanding, in the rush to provide health insurance coverage to as many people as is economically feasible, we may replace one kind of disparity (lack of health insurance) with another kind of disparity (lack of adequate health insurance). Thus, this paper explores the concept of “essential benefits”, arguing that the “essential health benefits package” in the ACA should be one that optimally satisfies the basic needs of the people covered.     

Child Health Benefits Packages: Lessons from Minnesota for State Children's Health Insurance Programs

The State Children's Health Insurance Program (SCHIP) provides state maternal and child health (MCH) programs an opportunity to assure comprehensive health services are available to children through the selection of an appropriate benefits package. Minnesota had this chance in 1994 when the state was considering development of a universal standard benefits set. While the Minnesota MCH program was not at the policy table, they worked through a process that increased their influence on decisions by responding to a legislative call for a definition of appropriate and necessary care. This definition was ultimately adopted by policymakers in creating the recommended Universal Standard Benefits Set. This experience may provide an important incentive to other state MCH programs seeking opportunities to participate in the development of state SCHIP plans.